David J Taber1,2, Mulugeta Gebregziabher3, Aurora Posadas4, Caitlin Schaffner1, Leonard E Egede5, Prabhakar K Baliga6. 1. Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC. 2. Department of Pharmacy Services, Ralph H Johnson VAMC, Charleston, SC. 3. Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC. 4. Division of Transplant Nephrology, College of Medicine, Medical University of South Carolina, Charleston, SC. 5. Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI. 6. Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC.
Abstract
INTRODUCTION: Health disparities in African-American (AA) kidney transplant recipients compared with non-AA recipients are well established. Cardiovascular disease (CVD) risk control is a significant mediator of this disparity. OBJECTIVE: To assess the efficacy of improved medication safety, CVD risk control, and racial disparities in kidney transplant recipients. METHODS: Prospective, pharmacist-led, technology-aided, 6-month interventional clinical trial. A total of 60 kidney recipients with diabetes and hypertension were enrolled. Patients had to be at least one-year post transplant with stable graft function. Primary outcome measured included hypertension, diabetes, and lipid control using intent-to-treat analyses, with differences assessed between AA and non-AA recipients. RESULTS: The participants mean age was 59 years, with 42% being female and 68% being AA. Overall, patients demonstrated improvements in blood pressure <140/90 mmHg (baseline 50% vs. end of study 68%, p=0.054) and hemoglobin A1c <7% (baseline 33% vs. end of study 47%, p=0.061). AAs demonstrated a significant reduction from baseline in systolic blood pressure (-0.86 mmHg per month, p=0.026), which was not evident in non-AAs (-0.13 mmHg per month, p=0.865). Mean HgbA1c decreased from baseline in the overall group (-0.12% per month, p=0.003), which was similar within AAs (-0.11% per month, p=0.004) and non-AAs (-0.14% per month, p=0.029). There were no changes in low-density lipoproteins, triglycerides, or high-density lipoproteins over the course of the study. Medication errors were significantly reduced and self-reported medication adherence significantly improved over the course of the study. CONCLUSION: These results demonstrate the potential efficacy of a pharmacist-led, technology-aided, educational intervention in improving medication safety, diabetes, and hypertension and reducing racial disparities in AA kidney transplant recipients. (ClinicalTrials.gov NCT02763943).
INTRODUCTION: Health disparities in African-American (AA) kidney transplant recipients compared with non-AA recipients are well established. Cardiovascular disease (CVD) risk control is a significant mediator of this disparity. OBJECTIVE: To assess the efficacy of improved medication safety, CVD risk control, and racial disparities in kidney transplant recipients. METHODS: Prospective, pharmacist-led, technology-aided, 6-month interventional clinical trial. A total of 60 kidney recipients with diabetes and hypertension were enrolled. Patients had to be at least one-year post transplant with stable graft function. Primary outcome measured included hypertension, diabetes, and lipid control using intent-to-treat analyses, with differences assessed between AA and non-AA recipients. RESULTS: The participants mean age was 59 years, with 42% being female and 68% being AA. Overall, patients demonstrated improvements in blood pressure <140/90 mmHg (baseline 50% vs. end of study 68%, p=0.054) and hemoglobin A1c <7% (baseline 33% vs. end of study 47%, p=0.061). AAs demonstrated a significant reduction from baseline in systolic blood pressure (-0.86 mmHg per month, p=0.026), which was not evident in non-AAs (-0.13 mmHg per month, p=0.865). Mean HgbA1c decreased from baseline in the overall group (-0.12% per month, p=0.003), which was similar within AAs (-0.11% per month, p=0.004) and non-AAs (-0.14% per month, p=0.029). There were no changes in low-density lipoproteins, triglycerides, or high-density lipoproteins over the course of the study. Medication errors were significantly reduced and self-reported medication adherence significantly improved over the course of the study. CONCLUSION: These results demonstrate the potential efficacy of a pharmacist-led, technology-aided, educational intervention in improving medication safety, diabetes, and hypertension and reducing racial disparities in AA kidney transplant recipients. (ClinicalTrials.gov NCT02763943).
Authors: Fernando G Cosio; Todd E Pesavento; Sunny Kim; Kwame Osei; Mitchell Henry; Ronald M Ferguson Journal: Kidney Int Date: 2002-10 Impact factor: 10.612
Authors: Aram V Chobanian; George L Bakris; Henry R Black; William C Cushman; Lee A Green; Joseph L Izzo; Daniel W Jones; Barry J Materson; Suzanne Oparil; Jackson T Wright; Edward J Roccella Journal: JAMA Date: 2003-05-14 Impact factor: 56.272
Authors: James N Fleming; McLean D Pollock; David J Taber; John W McGillicuddy; Clarissa J Diamantidis; Sharron L Docherty; Eileen T Chambers Journal: Transplant Direct Date: 2022-02-21